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Flashcards in Lung & Heart Deck (10):
1

How do you distinguish pulmonary arterial/precapillary htn from pulmonary venous/postcapillary htn?

Arterial=not due to L heart disease
PAP>25 resting/30 exercise
PCWP<15 mmHg

Venous=due to L heart disease
PAP>25 resting/30 exercise
PCWP>15 mmHg

2

What are the stages of syndromes that occur when PCWP increases in left heart disease?

Normal: PCWP 8-12

Pulmonary vascular redistribution: PCWP 12-18
Pulm blood flow redirected to upper lobes; can be asymptomatic

Pulm Interstitial Edema: PCWP>18
Fluid gets into lung itself, Kerley B lines=interlobular edema

Pulmonary Edema: PCWP>25
White alveolar lung --> difficulty breathing, cough up blood

*Chronic pt can accomodate a higher PCWP than an acute pt = fewer radiological and clinical signs

3

What are the symptoms of pulmonary venous congestion?

Dyspnea

Orthopnea

Paroxysmal nocturnal dyspnea

Hemoptysis

Cough

Fatigue

Can leads to RV failure

4

How can you distinguish heart or lung causes of dyspnea?

Troponin in blood=sign of ischemic heart disease

BNP increases when LAP increases (does not do this in pt with lung disease)

5

What's the differential of dyspnea?

Suden onset? Pulm edema, pulm embolism, pneumothorax, asthma

On exertion? heart failure, pregnancy, pleural effusion from cancer

Anemia, obesity, deconditioning, anxiety

6

What is the differential for cough due to heart disease?

PVH

pulmonary embolism

aortic aneurism

compression tracheobronchial tree

7

Why does the right ventricle fail in PVH?

It's sensitive to P and V overloads (thin)

8

What is the result of RV failure?

Systemic venous congestion: ascites, RUQ discomfort (liver fluid), ascites, cyanosis (central or peripheral)

9

What is the differential for edema?

CHORD

Cardiac

Hepatic

Obstruct SVC (lung cancer)

Renal

DVT

10

What's the differential for RV failure?

L heart failure=most common

RV infarction

Parenchymal pulmonary disease "cor pulmonale" = R heart failure due to increase bp in PA's and RV or heart

Pulmonary vascular disease (emboli, primary pulmonary htn)